To Improve the Decision-Making Process in the Aftermath of a Sudden Impact Natural Disaster

Exercise 1

State level

Objective:

To improve the decision-making process in the aftermath of a sudden impact natural disaster such an earthquake.

To familiarize the participants with the myths and realities of humanitarian assistance following a sudden-impact disaster resulting in a highly emotional and politicized context.

Scenario:

A major earthquake has stricken on October 15 at 7:35 am the state of NEPER, with 860,000 inhabitants, one of 12 states in the country DEARLAND (you have received and read the description of the country). The emergency situation is obvious, most of the officials are either isolated in the state capital Ministry of health ( some are working early!) or at home without power and unreliable telephone system. Cellulars are reportedly working in some areas of the statecapital but lines are almost always busy. Military radio communication is working with the capital Sto Foligro.

It is now 8:15 am. Boulder USGS station is indicating a magnitude of 7.5 on the Richter scale. (Foreign geological monitoring stations do not report the MM scale rating… why?). The local seismologic unit can be reached.

Your family is safe but you might have lost your home! You report for duty to the MoH or other department where you are assigned and you could see for yourself the devastation in the narrow streets of the ancient and historical city. You could not pass by car even in the main arteries and ended walking to the office.

Around 9:00 am, the minister of health, a surgeon who recently assumed his post, is calling his key staff to discuss the measures to take on the basis of the information trickling up from the affected areas in the state capital and the rest of the province.

Your First Task:

Minute 1

A role may have been assigned to you. Now, you must evaluate the information coming in and advice the Minister or inform him of the decisions that you have taken or are taking. It is an improvised or ad hoc health emergency committee, as the state ministry of health had no established a full time disaster program (the post has been used for something more pressing) and the committee has never met . During the past hurricane ISIS, Neper has not been affected and failed to establish and test procedures as required.

You will note that several students have not been assigned a role. Your first task is to decide which functions are required or useful for the state emergency committee and should be assigned this role to one of the participants who have not received one in your group.

Each student may have up to two ‘hats’ i.e. two functions. For instance, one person may combine the function of epidemiologist with that of representative of a NGO. The students assigned the function of Minister of Health, chairman of the Committee or of the director of the Emergency office of MoH cannot assume another role or function.

You have 15 minutes to establish your full blown committee, anticipate the problems you will face and start receiving preliminary information on the damages and needs/ requests/offer for emergency assistance.

Messages from different sources will arrive at intervals: You must analyze the information, you may ask background information on the country and decide whether it is acted by one technical member of the committee or needs to be discussed by the committee at large (political, sensitive or needs inter departmental coordination.

Be reminded that it is an emergency situation, victims are likely to be many, your resources (and experience) are limited and that time is flying. Do not fall in the trap of running an emergency operation by committee consensus.

In the first hours or even days of a disaster, communications are difficult and you will be on your own! Be ready to pass information to the national level as soon as the communication is reestablished

One person should act as raporteur and make a brief presentation after the exercise.

Possible Roles at Local (State) level

1. State Minister of health, chairman of the Emergency Committee

2. Acting disaster health coordinator and director of the Emergency Room of the main hospital - secretary of the EC

3. Junior State epidemiologist – he replaces the Chief epidemiologist who did not report for duty due to great personnel losses in his family

4. Chief pharmacist of the MoH (also responsible for essential drugs and enforcing national regulations on Drugs) political appointee – recently nominated

5. Representative of the Director of the Neper MoH hospital (250 Beds)

6. Chief environmental health inspector (Food, water, sewage, vector control)

------Optional functions:------

Chief Medical officer – overseeing all technical services – Director, Medical Services (hospitals, PHC, gender issues, indigenous health)

8. Representative of the program of indigenous health ( an influential minority of the population)

9. Director of Administration (finances and procurement) , Neper MoH

10. Representative of FSS (FSS hospital with 460 beds in Nepercity, smaller facilities (15 30 beds) in the state

11. Representative of the Armed forces

12. Representative of the State EC (Civil protection)

13. Representative of the National Red Cross Society

14. Representative of the Governor office

15. Representative(s) NGO’s (Several have large ongoing health projects in the State)

16. Representative of the Medical Association / private sector (There is a small but modern and eclectic clinic (23 beds) with one excellent orthopedist)

17. Public information officer or representative of the mass media

18. others?

Political Background:

The country is politically divided. The presidential elections, one year ago, were marred by allegations of fraud and violence. The conservative party, in power for over 15 years, succeeded to retain the lead by a small margin. The opposition is strong, better articulated and with solid roots in the lowest economic classes especially outside the two major urban areas.

State Governors elections run simultaneously with the presidential election resulted in candidates from the opposition ousting 5 conservative incumbents in the poorest states including Neper and Walgram.

The tensions at the borders with the Southern neighboring country remain high. Large stretches of land are contested and heavily mined. Strong military forces are present at the border of the state (in fact on both sides!).

The new Governor from the opposition has a strong popular backing and is highly suspicious of the central level willingness to assist in the development of one the poorest states of the country. He is aware that the responsibility for the response is primarily at state level (it means his) and is resentful of heavy handed initiatives taken by the MoH at national level without consultation with his minister. He appointed 10 months ago his friend, a surgeon as his Minister of health. The first move of the new minister has been to replace most of the managers and executive level officials (formerly appointed by the conservative party in power at national level). Given the lack of human resources of the states, few of the appointees have the experience or caliber for their job.

The UN family (WHO/PAHO, UNICEF, UNDP, UNFPA…) is running projects in the state including on landmines, peace initiative, water and AIDS.

At least 8 major international NGOs are active in the state among them MSF, CARE, CRS, OXFAM and Save the children. Red Cross has a significant role in blood bank and food distribution but a weak administrative capacity. The local branch director is respected and in place for over 20 years.

Administrative data on the State of NEPER.

Please refer first to the data on Dearland.

Neper is ranking as the second poorest state in Dearland. With a population of 860,000 predominantly of English speaking culture with a small but very vocal indigenous minority in the mountainous border areas, it is divided in 7 districts as follows:

· District 1: with the state capital Nepercity – population 370,000

· District 2, 3 & 4: (population 70,000 each not including the military forces stationed. Information is classified.) They are bordering the Western Neighbor country (“less-than-Friendly Neighbor)

· District 5: North of Nepercity is the poorest district in Dearland. Population mostly rural of 40,000.

· District 6: East of Nepercity, the most affluent of the state has a population of 130,000

· District 7: bordering the state of Vamua has a population of 110,000

Each district is divided in municipalities of different sizes and numbers.

The state is divided in 8 health sectors which do not coincide with administrative divisions. For instance the Capital District is divided in two sectors, one for the metropolitain area and one for the rural area. Others are roughly similar to political districts but with changes to reflect the coverage (catching area) of the health services and hospitals.

There are two main hospitals in the state and of course both are in Nepercity:

The General Hospital of the ministry of health with 250 beds is poorly equipped and understaffed. The hospital has basic surgery including orthopedic. Analysis of disaster vulnerability of the installation has never been done. The structure is 125 year old and located in he center and most crowded part of Nepercity. It serves mainly the poor, unemployed or undocumented.

2. The Employees Hospital from FSS: a better equipped hospital of 460 beds with advanced surgery, blood bank, intensive care unit and a burn unit of 3 beds. No study of the structural vulnerability has been carried out. WHO’s offer to undertake this study has been gratefully acknowledged but never acted upon. They completed a review of their disaster plan and had a drill with simulation of evacuation 7 months ago. The structure is relatively recent (app. 25 years of age) and located in the suburb, it is surrounded by a park. It is normally reserved for patients covered by a work insurance 9compulsory in Dearland)

In the rest of the state, clinics (10-20 beds) or health centers (2-5 beds) are providing basic medical hospital care to those fortunate to be living in the catching area.

Housing is principally of adobe (mud bricks) except in the residential areas of Nepercity. There are only 4 buildings with more than 4 floors (Business offices and one residential) in the state capital.

Roles to be attributed (cut and assign randomly)

LOCAL: State Minister of health, chairman of the Emergency Committee

LOCAL: Acting disaster health coordinator and director of the Emergency Room of the main hospital - secretary of the EC

LOCAL: Junior State epidemiologist – he replaces the Chief epidemiologist who did not report for duty due to great personnel losses in his family

LOCAL: Chief pharmacist of the MoH (also responsible for essential drugs and enforcing national regulations on Drugs) political appointee – recently nominated

LOCAL: Representative of the Director of the Neper MoH hospital (250 Beds)

LOCAL: Chief environmental health inspector (Food, water, sewage, vector control)

LOCAL – ROLE TO BE ASSIGNED BY THE EMERGENCY COMMITTEE

LOCAL – ROLE TO BE ASSIGNED BY THE EMERGENCY COMMITTEE